Cleft Lip and Palate

Long before children are born, during certain stages of development, the roof of the mouth and the upper lip normally join and grow together. The lip and the palate develop at two different stages and occasionally, about one in 800 children do not complete these two stages of development. This causes the children to be born with a separation of the upper lip, a separation of the palate or both. When this occurs, children will need to undergo Cleft Lip and Palate surgery.

Cleft Lip

There are different levels of cleft lips. Deformities can range from a simple notch in the red part of the upper lip to a complete separation of the lip that extends all the way to the nose. Cleft lip can occur on either one or both sides of the lip. While this deformity is not life threatening in any way, it can cause problems with feeding. It is harder for children with cleft lip to maximize suction while eating. Babies that suffer from this are given special bottles in order to feed properly until their surgery is performed.

Surgeries are usually performed when a child reaches about 10 weeks. To repair a cleft lip, the surgeon will make an incision on either side of the cleft from the mouth into the nostril. After the incision is made, the surgeon will turn the darker pink portion of the cleft down and then pull the skin and muscle of the lip together in order to close the separation. This surgery should successfully restore normal lip shape and muscle function. This surgery can also improve the nostril deformity associated with cleft lip, or it can be improved during a later surgery.

It will take a child a few weeks to fully recover from this surgery. Special feeding instructions will be provided as well as elbow restraints so that the child cannot touch the stitches while the wound is healing. If dressings are applied after the procedure, they will usually be removed within the first two days, and stitches will either dissolve or be removed within five days. The scar(s) will eventually fade but never disappear. However, in most children they are hardly noticeable because of the shadow created by the nose and upper lip.

Cleft Palate

Just like cleft lips, there are different levels of cleft palates. Some children will have a small separation at the very back of the roof of their mouth whereas others will have a complete separation from front to back. Also similar to cleft lips, cleft palates can appear on one or both sides of the mouth. Compared to cleft lips, cleft palates involve a much more extensive surgery. Most children do not undergo this surgery until they are at least 9 months old.

The cleft palate procedure will begin with an incision on both sides of the separation. The surgeon will move tissue from either side of the cleft to the center of the roof of the mouth. The surgeon will join muscle together to rebuild the palate which will provide the palate with enough length that a child will be able to eat and learn to properly speak.

Your child will feel pain and discomfort during the first few days after the surgery. It will be difficult to eat; so many children are fed intravenously directly following the surgery. Elbow restraints will also be used to keep the child from touching the injured area. The surgeon will guide you on how to feed the child until the incision properly heals.

Risks

Like all surgical procedures, cleft lip and palate procedures do come with a certain amount of risk. The most common risk is asymmetry. The surgery may reconstruct the lip and/or palate separation(s), but upon healing, the child's features may be very uneven. Oftentimes a later procedure can fix this. A few other risks include:

All of these risks are rare but treatable. Improper healing and poor speech development will require additional surgeries in order to solve the problems. Speaking with a surgeon about all risks associated with cleft lip and palate surgeries will ensure that the procedure is right for your child.

Results

While cleft lip and palate surgery will solve the immediate problem, it is imperative that parents realize that the cleft lip and palate can lead to several complicated problems. Most surgeons recommend that parents take a team approach. Working with a cleft team will ensure that your child has the best possible chances of normal development.

A cleft team usually includes a plastic surgeon, a pediatrician, a dentist, a hearing specialist, an ear-nose-throat specialist, a speech and language specialist, a social worker, a psychologist, a nurse and a genetic counselor. All of these professionals will work with your child to allow him or her to be taught normal eating habits, normal speech and language patterns as well as many other important developmental steps. It is important that throughout all of this, parents provide love and support for their child so that despite the defect, he or she can feel as normal as possible.